Periodic screening by mammography and/or breast palpation has been shown to have a significant impact on mortality rates for breast cancer among women age 50 years or older. Mammographic screening, however, is greatly underutilized in the U.S., and the majority of women are not receiving annual physician breast examinations. The long-term objectives of this project are to increase the number of women 50 years of age or older who obtain mammographic screening (at annual or other time intervals) and who have breast examinations performed by physicians and other skilled health professionals. The specific aims are related to achieving these objectives through public education, education of physicians and other health professionals, and the development of lower cost mammography. The research design involves three intervention areas (towns) in Suffolk County, NY and one control town in Nassau County, NY. Mass public education programs will involve approximately 95,000 women (age 50 years or older) in the intervention areas, and continuing medical education programs will involve more than 380 physicians. The physician education programs will include both didactic and practical (hands-on experience) components. In a subarea of one of the intervention towns, community outreach programs will utilize existing health centers to reach low socioeconomic areas with ethnic diversity. Outreach efforts will involve senior citizen and other community groups and women's organizations. Physician education programs will include courses on mammographic interpretation for radiologists. Quality assurance procedures for mammographic equipment will involve the participation of the Suffolk County Department of Health Services and the American Cancer Society, Long Island Division. This project will evaluate the impact and cost-effectiveness of public education, physician education, and lower-cost mammography services in terms of changes in knowledge, attitudes, and behavior with regard to mammography and breast palpation. The process by which the impact of these interventions occurs through changing knowledge, attitudes, and behavior of women and health professionals will be evaluated through periodic surveys of random samples of women age 50 years or older in all intervention areas and in the control area, and surveys of all physicians in appropriate specialities in these areas. The impact of these interventions on breast cancer stage distributions and breast cancer mortality rates will be examined, along with cost- benefit analyses, beginning in years three and four of the project.